CARE RECIPIENT WAIVER
REVIEW AND ACKNOWLEDGE
This waiver should only be signed after you have been referred for care and CDAIDE has requested you complete it.
If you have been asked to complete our income verification form ONLY, please click here.
CDAIDE’s support may include financial aid for urgent needs, access to health care, connection
to community resources, mentoring, counseling, and other measures to meet individual needs.
All of our services are offered with no strings attached.
CDAIDE takes your privacy seriously and wants to inform you about the protection of your
personal information. All volunteers and board members have signed a confidentiality
statement and understand that protecting your privacy is essential.
In consideration of my use of the services of CDAIDE, I for myself, my heirs, personal
representatives or assigns, do hereby release, waive, discharge, and covenant not to sue
CDAIDE and its directors, officers, employees and agents from liability from any and all all
claims including negligence resulting in personal injury, accidents, or illnesses (including death)
and property loss arising from use of CDAIDE’s services.
I hereby give permission to CDAIDE to share my circumstances and personal details (including
any identifying information I provide) with CDAIDE board members, relevant volunteers, the
individual who referred me for support, and Care Partners (such as physicians, counselors, etc.)
that might assist with my needs. This may involve referral and sharing of personal information
to other organizations that I agree to. Data on CDAIDE’s assistance and my personal
information will also be stored in CDAIDE’s database and in a charity tracking database, which
allows local agencies to collaborate. Demographic data may be shared with funding agencies.
No identifying details about my story, situation or personal information will be shared publicly
without an optional Media Release signed by me, if I wish to share my story more broadly to
If you plan to meet in person with any CDAIDE staff member or volunteer, please complete our COVID waiver.